Establishing a Successful Inotropic Therapy Sales Program

Transcription

1 Establishing a Successful Inotropic Therapy Sales Program Jan Ruel Juneau, RN, CRNI, Regional Sales Manager and Bill Miller, RPh, Branch Manager, CarePoint Partners, Metairie, LA

2 Top 4 Things to Know for CE 1. Make sure your BADGE IS SCANNED each time you enter a session to record your attendance. 2. Carry your Evaluation Packet with you to EVERY session. 3. Pharmacists, Pharmacy Technicians and Nurses need to track their hours on the Statement of Continuing Education Form as they go (the 2-page triplicate form, so press firmly!). 4. FOR CE: At your last session, total the hours and sign both pages of your Statement of Continuing Education Form. Keep the PINK copy for your records and place the YELLOW and WHITE copies in your CE Envelope. Make sure an Evaluation Form is in your CE Envelope for each session you attended (extra forms are available at the registration desk if you forgot to pick one up). Write your name and unique ID number (six digit number at the bottom of your name badge) in the designated area on the outside of the envelope, seal it, and place it in the drop box located near the 4/9/ registration area.

3 Jan Ruel Juneau and Bill Miller declare no conflicts of interest or financial interest in any service or product mentioned in this program. Clinical trials and off-label/investigational uses will not be discussed during this presentation. 4/9/2012 3

4 Objectives Define: Heart Failure & IV Inotropic Therapy Discuss the development of an Inotropic therapy program Identify steps in conducting a market analysis related to therapy and patient population Discuss operational needs for this out patient therapy How to successfully sell the program 4

5 Heart Failure Defined: Heart Failure is a condition in which the heart can t pump enough blood to meet the body s needs. In some cases, the heart can t fill with enough blood. In other cases, the heart can t pump blood to the rest of the body with enough force. Some people have both problems. 5.8 million people in United Sates have heart failure Both children and adults can have the condition Currently, heart failure has no cure National Heart Lung and Blood Institute 5

6 The Stages of Heart Failure Class Class I Mild Class II Mild Class III Moderate Class IV Severe Patient Symptoms No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath). Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea. Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea. Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased. New York Heart Association 6

7 Heart Failure Causes / Risk Factors Most common Coronary heart disease High blood pressure Diabetes Previous Heart Attack Age > 65 Other causes Congenital Viral or bacterial Valvular Genetic Chemically induced Risk Factors Thyroid disease Alcohol abuse Diet / obesity Smoking Stress Sleep apnea 7

8 Treatment Options Lifestyle changes change habits diet / exercise rest Oral medications Surgical procedures Left Ventricular Assist Device (LVAD) IV Medications Heart Transplant Treatment may vary accordingly physician practice patient choice according to patient heart failure type and severity 8

9 IV Inotropic Therapy IV medication used to increase contractility of a poorly functioning heart muscle Inotropic therapy utilized for: Advanced heart failure, normally class 4 disease Patients awaiting transplant (Bridge to Transplant) to improve cardiac function and keep patients alive while waiting for heart Deferred Candidates Destination Therapy /Palliative 9

10 Medications Dobutamine Hydrochloride Synthetic catecholamine, which stimulates Beta receptors of the heart. Produces mild chronotropic, hypertensive, arrythmogenic and vasodilative effects Doses range from 2 20 mcg/kg/min Onset of action is with 1 2 minutes and peak effects may take up to 10 minutes Plasma half life is 2 minutes Elimination is renal May see tolerance develop and need increases 10

11 Medications Milrinone Lactate Phosphodiesterase inhibitor Dose range from 0.25 to 0.75 mcg/kg/min Both inotropic and vasodilator Increases myocardial contractility Half life 2 4 hours Does not show tolerance Elimination is renal 11

12 Our Beginning Early 1990 s worked in conjunction with an advanced heart failure/ heart transplant hospital and associated home infusion/home care agency to administer dobutamine at home (previously was administered in ICU) Case Study: JW 40 y/o female received a single dose of Adriamycin for treatment of metastatic breast cancer Sustained chemotherapy induced cardiomyopathy Patient became inotrope dependent Patient was deferred as a transplant candidate due to co morbidities Patient verbalized 2 last wishes: attend son s High School graduation attend daughter s wedding 12

13 Our Beginning (continued) Physician called hospital s home infusion department seeking a solution Requested continuous infusion of Dobutamine at home? Neither hospital nor home infusion had prior experience with therapy Patient was made aware that the team was looking into options but home inotrope therapy would be considered experimental 13

14 Our Beginning (continued) Initial collaboration consisted of 2 teams that would develop policy and procedures to provide therapy for this patients request Acute Care Team Physicians Nurse Pharmacist Heart Transplant team leaders Home Infusion Team Administrators Medical Director Infusion Nurse Specialist Pharmacist Discharge occurred approximately 1 week later with newly developed Policies and Procedures Plan of Care resulted in: Attained 2 last wishes Remained home for total of 7 months 14

15 What Came Next Physicians lecturing at National Cardiology Conferences Sharing the case study and successes of provided therapy Publishing articles Home Inotropic Therapy in Advanced Heart Failure: Cost Analysis and Clinical Outcomes CHEST November 1997 vol. 112 no Home Infusion staff received calls requesting information on therapy Home care agencies Infusion companies Acute care team started to request care for similar case scenarios Requested to provide therapy to patients who were actively on heart transplant list 20+ years of inotropic patient management 1000 s of patients later, we find ourselves here today 15

16 What We Learned Then, Still Applies Today Success of the program depends on: Data collected Demonstrated that we could Provide therapy successfully Decrease hospital length of stay Provide cost savings with heart failure patient population Provided additional option for patient with advanced heart failure diagnosis 16

17 Market Analysis Do your homework What is your region s advanced heart failure population? Heart Transplant Center? Region Advanced Heart Failure Clinics? What treatments are offered? Cardiologist Practice Patterns Do they treat advanced heart failure patients? Philosophy? Pro or con to inotrope? Qualifying account Yes, they have a need for home inotropes Current provider Are there opportunities for additional provider L VAD utilization 17

18 HIT Company Resource Analysis Clinical Staff Clinical Pharmacist with heart failure experience Nursing with HF experience Infusion Specialist Clinical Liaison Nurse Home Nursing support are they ready? Support Staff Intake department Pharmacy technicians Delivery personnel Equipment/ Supplies Warehouse manager Medication supplier Contracts 18

19 HIT Company Resource Analysis continued Service area coverage (regionally) Response time to patient Availability of emergency services Home care nursing partners Service area Assist with education Assist with policy and procedures Emergency Plan How patient population will be managed Re hospitalized? Financial stability Your ability to sustain increase in outstanding AR 19

20 Payer Qualifications Qualified Reimbursement Team Medicare / Medicaid/ Insurance coverage Authorization Data collection form Billing Collections Need to know coverage Covered by most contract insurance companies Medicare Inotropic Data Collection form Qualifiers Max oral meds 20% improvement in Cardiac Index or 20% decrease in Wedge Pressure Specific dosages Dosage for Milrinone is mcg/kg/min to 0.75 mcg/kg/min Dosage for Dobutamine is 2.5 mcg/kg/min to 10 mcg/kg/min Dosage for Dopamine is less than or equal to 5 mcg/kg/min 20

21 Medicare Data Collection Form Centers of Medicare and Medicaid Services. (1995). 21

22 Now You Are Ready To Sell! Very clinical oriented sell It s not always about slick brochures Have you done your homework? Know heart failure & terminology associated Knowledge of therapy Use Patient populations Medication Is operations ready? ~ one shot 22

23 Successful Selling Use current resources Proven performer for others within the facility reference other successful accounts Infectious Disease Oncology Neurology Case Managers Coordinators Social Workers 23

24 Successful Selling Sharing Data Re hospitalizations (pre transplant / deferred) Infection rates Satisfaction surveys Referral source satisfaction Patient Satisfaction Service coverage area Discuss the program you have in place Policies and Procedures 24

25 Sales (continued) Superior Customer Service Patient contact Follow up Patient satisfaction Go the extra mile Superior Clinical Services Accurate reporting Positive clinical outcomes Facility / acute team satisfaction Proactive 25

26 What does the future hold? Clinical Trials Mount Sinai School of Medicine SERCA2a CUPID Trial Phase II Delivered via adeno virus vector Stimulates production of an emzyme within cell enables heart to pump effectively Ventricular Assist Device LVAD (left), RVAD (right), or BiVAD (both) Internal pump External power Gene Therapy Ultrafiltration Aquapheresis Science Daily 26

27 Recapping Successful Programs Respected competent clinical team Proactive Knowledgeable of centers practice and protocols Patient satisfaction Data collection Positive outcomes Collaborative care Competent sales team Efficient / timely operational team Sales and Operational teams united 27

28 References National Heart Lung and Blood Institute. What is Heart Failure? Retrieved from topics/topics/hf/printall index.html New York Heart Association.(2002). NYHA Classification The Stages of Heart Failure. Retrieved from Centers of Medicare and Medicaid Services. (1995). Palmetto Government Benefits Administrators The Region C Medicare Advisory. Retrieved from Science Daily. New Gene Therapy for Heart Failure Developed. Retrieved from 28

29 Learning Assessment Questions & Answers Please refer to the NHIA Annual Conference & Exposition 2012 On Site Program for a brief post test. jjuneau@carepointpartners.com bmiller@carepointpartners.com 4/9/